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420 Aquatic Dr RES24-0186 Application S.-0-A�J?,, BUILDING PERMIT APPLICATION FOR INTERNALOFFIfC�E`USIE,�ONLY ,: City of Atlantic Beach Building Department PERMIT# ?5214-U It n u 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process "-J% ''' 7 Phone: (904) 247-5826 Email: Building-Dept(a coab.us Job Address 11 Z17 19tJQ Z`/C Drive tle ( P tto-o- C Sect e. h FF• 32235 RE# Legal Description Aja-7/ /7--2$ -2 96A (n)alC O'urd h,5 .Loe , j) Valuation of Work(Replacement Cost) Z 1 CM 1 Heated/Cooled SF Non-Heated/Cooled SF •Class of Work: LI New ❑Addition ciAlteration SIRepair ❑Move (Demo ❑Pool E Window/Door • Use of existing/proposed structure(s): ❑Commercial WResidential • If existing structure, is a fire sprinkler system installed? FIlYes LI No •Will tree(s) be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) ❑ No Describe in detail the type of work to be p(---0\c-e_ C od�� ,� fi F DPI/ ,�,/ b4 et c).3-7 ` —� �Rcro �r) � eP`n �L � �o� G� —�toi5 re— �Je--rtr _Ue `�'o` C s i ,r, y !a LCot \07) c.‹. iZ' D oG-/J' l� t t0. C . Florida Product Approval# FL /3 / `?Z (For multiple products use Product Approval Information Sheet) Property Owner Information Name it rie/) Z 0 P7'70 -A Phone Address 1It6 (5 „taxa') Dr. 3 x C�/i City 0OLCC. 5PcQC' State FL Zip 322cS(''-> Email Owner or Agent(If Agent, Power of Attorney orrAAgencyy Letter Required) Contractor Information Name of Company �o/' P., o� /r Jr c 11114 Phone�/bJ yr/4-des-g. Address 4t 74 (,t'!. Docks/def Dr. City Y(XX . State PL Zip 32z ,J 7 Qualifying Agent O/)/0 Pte.k a 17O v /C State Certification/Registration#G PG # /33_3/q5 Email /Y)ppft2V ,Lcf)OV/CGet / f�t:2400,�p/� Job Site Contact Number goy -5717 -2 ..'SC, Worker's Compensation Insurer / OR Exempt Expiration Date X 1,3 / 20 Z.5 . /, Architect's Name Email 2 . Phone Engineer's Name .7- Email % , Phone ..-->"r Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this city/county, and there may be additional permits required from other governmental entities such as water management districts,state agencies, or federal agencies. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. **WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMS CEMENT. ---(/7 (Signature of Owner or Agent) (SignAture of Contractor) Signed and sworn to(or affirmed) before me this day of Signed and sworn to(or affix ed) before me this 2 day of , by Ml7`S'c. , '- ')-2 by=Y\r S / C flCC.i( HOWC- Signature of Notary Signature of Notary S:::— A ,...frTh•-• ack1,--e- [ I Personally Known OR [ I Produced Identification [ j Personally Known OR Produced Identification Type of Identification: Type of•lt iF::"^ ......,, irCtAS-e-" r .`:';F.., LADAYIJA NICHOLS i MY COMMISSION#HH 226065 `,'- '�` EXPIRES:February 8,2026 'enVi��.r• .i4�•i•-ice..r,P.. BUILDING PERMIT APPLICATION xoRrnirERNALOFFICEUSEONLY City of Atlantic Beach Building Department PERMIT ts \AI,. . ..:., 800 Seminole Road,Atlantic Beach,FL 32233 "ALL Information required to process Phone:(904) 247-5826 Email:@uilding-Dep1@SQiut Job Addi ess 11Z17 A9vgt/C .Dr;ve , AU#-titre 8ectC .F. 3______.213 _ "" REa Legal Description 'j ;— , /7-2S -2 9e A L!.." - ,mien o / Valuation of Work(Replacement Cost) Heated/Cooled SF Non-Heated/Cooled SF •Class of Work. [l New [Addition 'Alteration ,Repair ❑Move ❑Demo n Pool ❑Window/Door •Use of exisung/proposed structure(s) ❑commercial wResidential •If existing structure is a fire sprinkler system installed?QYesENo •Will tree(s)be removed in association with proposed project? 0 Yes (Must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be erformed: ,� � =i_ FSR Cita `t :i-��pc°`ce-J ' q—Ar1 pr- ter— ..-T . —Oloi56t.7r-e- b rr@.r- ti), 6t_ rR 0' tt —lie l�ftcst s1�'ny tad 1 c f) ult4i DSS rG o. c. Florida Product Approval p FL /3, 9 2- (For multiple products use Produ" `om "i'^rnrmnn0n`heel) '�rfe O 2 �"°" Phone Property Owner Information Name r) Z Address (46 (5 .[Leon Dr. �..�etACA City 3vt,x,, aedAC4 State FL Zip .3ZcsQ Email �M'Jl1, Solrtoconc,e iO p0 ner or Agent(If Agent,Power of Attorney or/Agencyy Letter Required) b_ r 32 Zy Contractor Information Name of Company telo� P'.I' Ar Jr/it4 rie. Phone 5iIii S/4-1e-�.c Address 424 74 CY/. ,C6c4cs;de r Dr. City OLX . State RL Zip 3zZ S Qualifying Agent / t/YpIJ 2A>k a no r% IC State Certification/Registrationit G ec #/3 3,3/9 5 Email /10 ft tj>Eq /e y400,ep/-J lob Site Contact Number WY -.57 17 -.215c 5c SArchWorker's Compensation Insurer OR Exempt IN Expiration Date /3 /ZG z-5- Architect's itect's Name % • Email • Pnone • ')... Engineer's Name -7• Email % . Phone /''_ Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc NO t ICE In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this city/county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. ••WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT It IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 72 . /1 -- ___.. (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me this day of by _ by Il Signature of Notary Signature of Notary ( I Personal) - OR I I Produced Identification I Personally Known OR [ I Produced Identification •„+„ /� �q ��/ Type of Identification-_. -a CALIFORNIA JURAT GOVERNMENT CODE§ 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of A d e Subscribed and/sworn to or affirmed)before me on y t -' , 20 if by this da of %�/ .. Date onth Year j� (1) / A ' /I f-Y '�,�'?f_'f'1z0 (and(2) ), �� ,, MAjty v.KUSNIER ame(s)of Signer(s) • Notary Pt.bdc•California ` = Los Angeles County E ,,'x- ,•,,a7;+.j r Commission•2357940 proved to me on the basis of satisfactory evidence to t, • " My Comm.Expires may 17,2025 be the person(s)who appeared before me. Si9 naturey Si ' /1141144"---) Place Notary Seal and/or Stamp Above lure of No ry Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document, • il/i' Title or Type of Document: // • / 1L/. JIL Document Date: I .. Number of Pages: Signer(s)Other Than Named Above: Alt ©2019 National Notary Association NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of FL County of DUVAL To whom it may concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes, the following information Is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved: 38-71 17-2S-29E AQUATIC GARDENS LOT 5-D Address of property being improved: 420 AQUATIC DRIVE . ATLANTIC BEACH, FL. 32233 General description of improvements: Hardie T1-11 Replacement. owner Darienzo Damon A. Address 14615 Laggon Dr. Jacksonville Beach, FL. 32250 Owner's interest in site of the improvement 100% Fee Simple Titleholder(if other than owner) N/A Name N/A Address N/A Contractor HOME REMODELING MAINTENANCE INC Address 10471 W.Docksider De.Jacksonville,FL.32257 Phone No. (904)514-2856 Fax No. N/A Surety(if any) N/A Address N/A Amount of bond$ N/A Phone No. N/A Fax No. N/A Name and address of any person making a loan for the construction of the improvements. Name Address Phone No Fax No. Name of person within the State of Florida,other than himself or herself,designated by owner upon whom notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Name Address Phone No. Fax No Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER </-?2 2 _,2� (/ (/ DATE I Signed. _ Before me day of iUr tve- :. . .-.•.. • as personally appeared herein byL�` himself/herself and affirms all statements and de•-rations herein 4 Doc#2024130614,OR BK 21092 Page 785, are true and accurate Number Pages:2 Recorded 06/18/2024 02:53 PM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY Notary Pcblic at Large.State• . County of RECORDING $18.50 My commission expires. Personally Known Produced Identifica P. CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of Californiaf � A-lijele- Subscribed County of L1 ) and sworn to (or affirmed) before me on this '�/ day of Ata5 , 20tr'�, by Date MoYear (1—All14'140etitleir-N-06117-6 (and(2) ' " ), N me(s)of Signer(s) i-• -,, MARY V.KUSNIER Notary Public•California rproved to me on the basis of satisfactory evidence to � � - Los Angeles County � , i,.• Commission 0 2357940 be the person(s)who appeared before me. L, • ' My Comm.Expires May 17,2025 Signature-1/ - ii � Place Notary Seal and/or Stamp Above Sig/tore of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: �/ to 1W 00nOtateenteift— if Yp 1Document Date: C/�,� ) Number of Pages: Signer(s) Other Than Named Above: /412kye-- i tomr000tter-•- - ... .. .4 4 .-• 4 :-: 4 : 4 :. 4 : 7.•.4. • 4 4 4 • ompoolpeoommomoto ©2019 National Notary Association